Pulmonary complications following lung resection - A comprehensive analysis of incidence and possible risk factors

Study objectives: To assess the incidence and clinical implications of post operative pulmonary complications (PPCs) after lung resection, and to ident ify possible associated risk factors. Design: Retrospective study. Setting: An 885-bed teaching hospital. Patients and methods: We reviewed all patients undergoing lung resection du ring a 3-year period. The following information was recorded: preoperative assessment (including pulmonary function tests), clinical parameters, and i ntraoperative and postoperative events. Pulmonary complications mere noted according to a precise definition. The risk of PPCs associated with selecte d factors was evaluated using multiple logistic regression analysis to esti mate odds ratios (ORs) and 95% confidence intervals (CIs). Results: Two hundred sixty-six patients were studied (87 after pneumonectom y, 142 after lobectomy, and 37 after wedge resection). Sixty-eight patients (25%) experienced PPCs, and 20 patients (7.5%) died during the 30 days fol lowing the surgical procedure. An American Society of Anesthesiology (ASA) score greater than or equal to3 (OR, 2.11; 95% CI, 1.07 to 4.16; p < 0.02), an operating time >80 min (OR, 2.08; 95% CI, 1.09 to 3.97; p < 0.02), and the need for postoperative mechanical ventilation >48 min (OR, 1.96; 95% CI , 1.02 to 3.75; p < 0.04) were independent factors associated,vith the deve lopment of PPCs, which was, in turn, associated with an increased mortality rate and the length of ICU or surgical ward stay. Conclusions: Our results confirm the relevance of the ASA score in a select ed population and stress the importance of the length of the surgical proce dure and the need for postoperative mechanical ventilation in the developme nt of PPCs. In addition, preoperative pulmonary function tests do not appea r to contribute to the identification of high-risk patients.